1. MICHAL KRZYZANOWSKI, ScD, PhD PM health impacts, Amman, Nov 2015 1 Visiting Professor, Kings College London PARTICULATE MATTER AND HEALTH: Update on WHO’s view on its impact on health with focus on mineral dust 1 st AFRICA/MIDDLE-EAST EXPERT MEETING AND WORKSHOP ON THE HEALTH IMPACT OF AIRBORNE DUST AMMAN, JORDAN, 2-5 NOVEMBER 2015

2. This presentation: PM levels and trends; Scientific evidence on health effects of particulate matter – results of recent research; Role of desert dust in causing health effects. PM health impacts, Amman, Nov 2015 2

3. PM 10 and PM 2.5 particle size PM health impacts, Amman, Nov 2015 3 EEA 2013

4. Sources of PM PM health impacts, Amman, Nov 2015 4 F. Brown/AFP

5. Amman, 8 Dec 2014 PM health impacts, Amman, Nov 2015 5

6. Dust storm in Homs, Syria, 7.09.2015 PM health impacts, Amman, Nov 2015 6 Omar Sandiki / Reuters

7. Global decadal (2001-2010) PM 2.5 concentrations PM health impacts, Amman, Nov 2015 7 Total satellite- derived PM 2.5 Dust and sea salt removed Van Donkelaar et al. 2015

8. Population-weighted PM 2.5 long term means and trends PM health impacts, Amman, Nov 2015 8 Van Donkelaar et al. 2015

9. This presentation: PM levels and trends; Scientific evidence on health effects of particulate matter – results of recent research; Role of desert dust in causing health effects. PM health impacts, Amman, Nov 2015 9

10. WHO AQG: GLOBAL UPDATE 2005: SUMMARY OF AQG VALUES PollutantAveraging timeAQG value Particulate matter PM 2.5 PM 10 1 year 24 hour (99 th percentile) 1 year 24 hour (99 th percentile) 10 µg/m 3 25 µg/m 3 20 µg/m 3 50 µg/m 3 Ozone, O 3 8 hour, daily maximum100 µg/m 3 Nitrogen dioxide, NO 2 1 year 1 hour 40 µg/m 3 200 µg/m 3 Sulfur dioxide, SO 2 24 hour 10 minute 20 µg/m 3 500 µg/m 3 AQG levels recommended to be achieved everywhere in order to significantly reduce the adverse health effects of pollution PM health impacts, Amman, Nov 2015 10 WHO 2006

11. REVIHAAP: selected conclusions on PM The scientific conclusions of the 2005 WHO Guidelines about the evidence for a causal link between PM 2.5 and adverse health outcomes in humans have been confirmed and strengthened and, thus, clearly remain valid. New studies on short- and long-term effects; Long-term exposures to PM 2.5 are a cause of cardiovascular mortality and morbidity; More insight on physiological effects and plausible biological mechanisms linking short- and long-term PM 2.5 exposure with mortality and morbidity; Studies linking long-term exposure to PM 2.5 to several new health outcomes (e.g. atherosclerosis, adverse birth outcomes, childhood respiratory disease). PM health impacts, Amman, Nov 2015 11 WHO 2013 http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/publications

12. IARC: Air pollution causes cancer PM health impacts, Amman, Nov 2015 12 The Lancet, 24 Oct 2013

13. Meta-analysis of the association between long-term exposure to PM 2.5 and all-cause (natural) mortality Forastiere et al, WHO 2014 13 PM health impacts, Amman, Nov 2015 2013/14

14. Mortality and long-term PM 2.5 exposure Results of a Canadian cohort study (2.1 million adults, 1991-2001) PM health impacts, Amman, Nov 2015 14 Crouse et al, EHP 2012 All non-accidental Cardiovascular Ischemic heart disease Cerebrovascular AQG

15. Long term PM 2.5 exposure and cardiovascular mortality PM health impacts, Amman, Nov 2015 15 per 10 µg/m 3 Forastiere et al, WHO 2014

16. Long term exposure to PM and incidence of acute coronary events in ESCAPE (100,166 people in 11 cohorts followed for average 11.5 years) PM health impacts, Amman, Nov 2015 16 Cesaroni et al. BMJ 2014

17. Health indicators functionally related to PM 2.5 or PM 10 exposure: HRAPIE project results Effects of long-term exposure: Mortality, all (natural) cause, age 30+ Mortality, CVDs, ischaemic heart disease, COPD, trachea, bronchus and lung cancer, age 30+; Post-neonatal infant mortality (all cause); Prevalence of bronchitis in children; Incidence of chronic bronchitis in adults. Effects of short-term exposure: Mortality, all cause, all ages; Hospital admissions for CV and respiratory diseases, all ages; Restricted activity days, all ages; Work days lost, age 20-65; Incidence of asthma symptoms in asthmatic children, age 5–19 years. PM health impacts, Amman, Nov 2015 17 WHO 2013 http://www.euro.who.int/en/health-topics/environment-and-health/air-quality/publications

18. Air pollution (PM) source types associated with health effects (conclusions of WHO REVIHAAP project) PM health impacts, Amman, Nov 2015 18 Carbonaceous material from traffic; Coal combustion (sulfate-contaminated particles); Oil or coal combustion in shipping, power generation, metal industry; Biomass combustion (including residential wood combustion); Traffic-generated dust, including road, brake and tyre wear; Desert dust episodes. WHO 2013

19. This presentation: PM levels and trends; Scientific evidence on health effects of particulate matter – results of recent research; Role of desert dust in causing health effects. PM health impacts, Amman, Nov 2015 19

20. Effects of Saharan dust on association between mortality and PM 10-2.5 PM health impacts, Amman, Nov 2015 20 All natural Cardiac CerebrovascularRespiratory Increase in risk of death (%) per IQR PM 10-2.5 (10.8 µg/m 3 ) Time series study in Rome, Italy, with 80 423 deaths in 2001-2004 Mallone et al, EHP 2011

21. Risk of natural mortality associated with non-desert PM 10 and desert PM 10 in Southern Europe: MED-PARTICLES Study PM health impacts, Amman, Nov 2015 21 Non-desert PM 10 (10 µg/m³ increase) Desert PM 10 (10 µg/m³ increase) Staffogia et al. EHP 2015 0.55 (0.24, 0.87)0.65 (0.24, 1.04) % increase in risk (95% CI)

22. Acute myocardial infarction (AMI) and Asian dust (AD) Odds ratios for AD days vs. non-AD days PM health impacts, Amman, Nov 2015 22 A case-crossover study of hospitalization because of AMI among 3068 consecutive patients of 4 AMI centres in Fukuoka, Japan, and data for AD 2003-2010. Matsukawa et al, Circ Cardiovasc Qual Outcomes. 2014

23. The nature of pollutant materials carried in dust storms PM health impacts, Amman, Nov 2015 23 Biological material Goudi, Env Internat 2014

24. Desert dust health effects: conclusions of WHO REVIHAAP project After the 2005 global update of the WHO air quality guidelines, several new studies reported positive associations between short- term exposure to PM 10 or coarse particles and mortality during desert dust episodes; The results for cause-specific mortality or for hospitalizations have not been fully consistent for coarse particles and desert dust episodes; Evidence for an effect of desert dust on human health is increasing, but at the moment it is not clear whether crustal, anthropogenic, or biological components of dust are most strongly associated with the effects. PM health impacts, Amman, Nov 2015 24 WHO 2013

25. Conclusions Fine particulate matter (PM 2.5 ) causes cardiovascular diseases and rspiratory cancers, and is related to other health problems; Various sources (especially combustion) contribute to population exposure to PM and to its health effects; Health risk increases proportionally to the exposure level, also at relatively low PM concentrations (even below WHO AQG level); Desert dust contributes to the impacts of PM 2.5 mass but scientific evidence on the type and magnitude of health effects specific to desert dust is scarce: More research conducted in desert dust affected countries is needed to elucidate aspects of effects specific to those exposures. PM health impacts, Amman, Nov 2015 25 Thank you!

26. Three-year running average of satellite-derived PM 2.5 concentrations over Middle East PM health impacts, Amman, Nov 2015 26 19992011200820052002 Van Donkelaar et al. 2015

27. Long-term exposure to PM 10 and mortality. Dutch Environmental Longitudinal Study (DUELS) of 7.1 million adults (age 30+), 2004-2011 PM health impacts, Amman, Nov 2015 27 *RR(95%CI) per 10 µg/m 3 PM 10, Adjusted for age, gender, marital status, region of origin, household income 1.10(1.09-1.11)* 1.08(1.06-1.10)* 1.16(1.12-1.20)*1.30(1.25-1.35)* Median PM 10 = 29 µg/m 3, IQR=2.5 µg/m 3 Fischer et al, EHP 2015

28. Cardiovascular mortality excess risks (95% CIs) and IQR increases in sources of PM 2.5 (lag 2) Case cross-over study in Barcelona, 2003-2007 PM health impacts, Amman, Nov 2015 28 Ostro et al, EHP 2011 Multi-source models Single-source models B+traffic models

29. Cause-specific mortality and Asian dust or suspended particulate matter (SPM) Relative risks (RR) in a two-pollutant model PM health impacts, Amman, Nov 2015 29 Time-series analysis targeting ca. 1.4 million people aged 65+ living in 47 cities in western Japan (2005-10). SPM  PM 8 Kashima et al. Occup Environ Med 2012

30. Immune responses to different particles in desert dust PM health impacts, Amman, Nov 2015 30 Esmaeil et al. Am J Clin Exp Immunol 2014 Dcs = Dendritic cells MQs = Macrophages ILCs = Innate lymphoid cells TCs = T cytotoxic cells Th1 = T helper cell type 1 Th2 = T helper cell type 2 Th17 = T helper cell type 17

31. Health effects of PM 2.5 exposure PM health impacts, Amman, Nov 2015 31 HEAL 2013